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Archive for July, 2018

I didn’t think too much about the invitation to express interest in being a Faculty of Public Health examiner – it just felt like the right thing to do. Once I had applied and was approved, I was excited to join the team. So I was glad to be attending my first Examiner Training session in London on the 15th of March. The day was set aside for training, standard setting and question setting. These activities, at first, seemed obvious and possibly boring but they turned out to be anything but!

Once I had hopped off the tube at Great Portland Street, I made a dash across the road for the venue at Park Crescent Conference Centre. Arriving a few minutes late to a room full of colleagues from various places across the country who were mostly experienced examiners, I tip-toed in. I was eased into the room very quickly with kind smiles from around, chiefly from colleagues whom I had worked with years ago and hadn’t seen in a while. The business of the day quickly got past the examiner training which was delivered expertly by a colleague whose background was outside public health.

Then came time for the standard setting. This was everything I had not expected it to be. We went through questions, assessing each for the proportion of candidates at around training ‘entry’ level who we would expect to do just enough to pass that question. These were collated for all the examiners who were then given a chance to share the rationale for their scores and adjust, considering wider discussion, if they wished.

Mean scores, if within a limit of standard deviation, were accepted as the standard for a pass on that question. In all, what struck me most was the significant focus on the candidate. Where questions had even the slightest chance of not being very clear to a candidate, they were highlighted for change. The same approach was carried over into the question setting session where we had the opportunity to set new questions within our assigned examination sections. Each question was then peer-evaluated and honed, each time focusing on the candidate who would be sitting the examination to ensure it was clear and appropriate.

As the day ended, I was glad for the opportunity to catch up with colleagues whom I hadn’t seen in a while, meet new ones, and appreciate a process which positively surprised me in its ‘candidate-centredness’ and attention to detail. As I boarded my train back home to South East Wales, I couldn’t but have my attention drawn to acts of kindness I saw in the train from strangers, one to another. From the kind smiles to the considerate use of space and digital equipment, what I saw was very much like what I had seen all day at the examiner training sessions – genuine consideration of another’s needs. This warmed my heart very much and added to the lovely memories I have of being part of that session.

Written by Dr. Kelechi Nnoaham, Director of Public Health, Cwm Taf University Health Board, Wales.

I clearly remember starting public health training. It was nearly five years ago now, I’d just come off a string of night shifts on A&E and it took a month to get used to sitting down at a desk all day. I’ve enjoyed nearly every day of training and feel excited when I think of my future career in public health. I’m very pleased to welcome the new registrars and hope they enjoy training as much as I do.

One of the most special things about training is all the amazing opportunities that are available to us, it’s the perfect time to get as much experience as you can. Saying this, I remember finding everything a little confusing and daunting in my first couple of years, with so much on offer it’s hard to know what to choose. So here are a few of my top tips….

My main advice is not to focus on what you want to be (or think you want to be) at the end of training, but instead focus on what experiences you want to have during training. Get involved in things that get you in contact with registrars from other training regions. Everyone’s experiences of training are so different it can be really useful and interesting to hear about what other registrars are doing. One of my favourite ways of doing this was through helping with recruitment at the selection centre. Not only does this give something back to the specialty as they rely on the help of registrars to run the process to the high standard you will have experienced yourselves, but you’ll be there with registrars from all over the UK with plenty of time to socialise. Don’t forget that the registrars you are training with will be your colleagues when you get consultant posts!

My other piece of advice is to find out what is going on in Public Health beyond your day-to-day placements. This could be by attending conferences and training events or getting involved in some of the opportunities that FPH offers. I did this by joining the FPH Specialty Registrar Committee (SRC) and over the years this has become one of the highlights of my training. I initially joined as my regional rep because no one else wanted to do it, but I soon became immersed in the committee and found myself doing some fascinating work with them including representing public health registrars in discussions over the junior doctors’ contracts and shape of training proposals. I now have the privilege of being the Chair of the SRC and I am thrilled to be leading a committee who continually do such important work which benefits all registrars, like reviewing exams, sharing ideas and ensuring equity in training.

I would, of course, encourage you all to join the SRC – it’s a great way to meet people and gain an understanding of issues that affect public health training, workforce and practice. But if this is not for you there are several other opportunities you could take, such as joining a special interest group at FPH, or getting involved with your Union. This is your chance to make your training what you want so be proactive and get involved!

If you’re reading this and about to embark on public health training, congratulations! I can’t believe it’s a year since I started the training programme, what a year it has been.

I joined the Yorkshire and Humber training programme last August after completing medical school, foundation and general practice training. My first year has been less than full time based at the East Riding of Yorkshire Council, having done the Master’s in Public Health prior to starting. My placement has involved analyses of a rise in drug-related deaths, evaluation of influenza prevention in care homes, leading a musculoskeletal conditions health needs assessment and preparing for Part A.

One of the most striking things for me is the variety within the training programme, offering a fantastic opportunity to learn new skills and develop interests. People enter from a range of different backgrounds, and once on the programme no two registrar experiences will be exactly the same. We all cover the core learning outcomes, but there is a wide array of learning opportunities, different placements and out of programme options. Knowing yourself, getting out of your comfort zone and working on areas you’ve never encountered can help maximise these opportunities.

There is an overall training curriculum against which you need to demonstrate full achievement for every learning outcome by the end of the scheme, a separate syllabus for the Part A exam, and content information for Part B, all available on the faculty website. Using these to guide Master’s module choices and to plan pieces of work on placements helps achievement of the overall goal – getting through the exams and signing off the learning outcomes to become a Consultant. The list of learning outcomes can seem overwhelming at first, but soon become more manageable as you get more familiar with them and hear about how others have achieved them.

The first year involves adjustment to a new role, working out how to manage competing work demands and understanding how your organisation works and its interface with other organisations. Getting to know some of the Registrars already on the programme, being organised but realistic about how much you can take on or achieve in a given time frame and having regular meetings with your educational supervisor can really help get the most out of that first year. Meeting with colleagues not only in your own team but more widely within the council or other organisation where you are working can offer useful learning opportunities.

On reflection, as I approach the end of my first year I realise what a great year it has been. I have had excellent support from peers, supervisors and training programme directors, and am excited about where the training programme will take me next.

We’re delighted that the Public Health Dashboard has now been officially released and would like to thank all of those who fed in to its development over the past year.

In this blog, we’re pleased to share our thoughts on how, in your work across public health and local government, you can use the dashboard to help you in prioritising resources to improve the public’s health. And, we’re also pleased to let you know about some further work that Public Health England and the UK’s Faculty of Public Health (FPH) will be carrying forward jointly over the remainder of this year, offering further opportunities for the public health workforce to shape the Public Health Dashboard.

What is the Public Health Dashboard?

The Public Health Dashboard is an online, easy to use tool providing information at your fingertips on a number of indicators related to local activity to improve the public’s health and wellbeing. Its development was part of a wider Government drive to support transparency and local accountability for delivery across all public services and not just public health. You can learn more about the tool, the data it presents and how to use it here.

How can it be used?

If you’ve been following the development of the dashboard then you’ll know that Directors of Public Health and their teams are not its primary intended user audience. Rather, the dashboard is aimed at local decision-makers, such as senior council officers, to help inform their investment decisions and better support them to prioritise resource when it comes to improving the public’s health.

Tools like this one that help a non-public health professional audience make good public health investment decisions will be especially needed once the public health grant ring-fence is removed at some future date. We also hope that members of the public, the voluntary sector, and service providers will use the dashboard to learn more about service provision in their area and how it compares to other areas.

However, we also think that the public health workforce will find considerable value in using the Dashboard. When FPH was speaking to its members about some of the challenges they encounter when advocating for public health investment and influencing to achieve better health outcomes, they said that it was sometimes difficult to demonstrate the value of public health, in all of its complexity, in a way that was intelligible to a non-specialist audience. This is one of the reasons why FPH’s project on the future of public health funding includes a call for an improved dashboard tool — to help the public health community get better at making its case for resource and telling its story.

So, it’s our hope that public health teams will use the Public Health Dashboard to:

Champion investment in public health services

Raise the profile of public health with politicians and local residents

Help make the case clearly and simply for decisions about public health resource allocation priorities

Enable greater scrutiny of public health service delivery at the local level that can drive improvements in public health outcomes

What next?

At the moment the Public Health Dashboard includes the following local authority service areas:

Best start in life

Child obesity

Drug treatment

Alcohol treatment

NHS Health Checks

Sexual and reproductive health

Tobacco control

Air quality (interim indicator)

You’ll notice that, with the exception of air quality, the dashboard doesn’t currently include an indicator on the wider determinants of health. This is because it only includes indicators where there’s a clear relationship between council activity and public health service delivery.

However, based on feedback from FPH’s members and others, we’re now keen to further consider the potential for including indicators for the wider determinants of health in the dashboard. We agree with those who told us that it’s important for the Dashboard to reflect the context and environment in which service delivery is occurring and to facilitate a more place-based approach to public health priorities and investment at the local level.

That’s why over the coming months, PHE and FPH will together consult with FPH’s members and the wider public health community regarding the potential inclusion of wider determinants indicators to feature in the Public Health Dashboard. We’ll do this over a series of workshops in the autumn to develop a group of wider determinants indicators that meet the criteria for inclusion in the Dashboard. We know this is a complex and broad topic and we’re committed to taking the time to make sure we continue to engage with the public health community on it as the Public Health Dashboard develops.

Written by Richard Gleave, Deputy Chief Executive and Chief Operating Officer, Public Health England, and Professor John Middleton, President, FPH.

Maurice was brought up in London and Cornwall during the war, and educated at Ilford County High School for Boys. In 1949, he went to study medicine at University College Hospital Medical School in London. After graduation, he served as a Junior House Officer with a consultant surgeon in Portsmouth and at the Scott Isolation Hospital for Infectious diseases in Plymouth, where he acquired experience in general and genito-urinary medicine.

Having qualified as a Doctor in 1955, National Service took Maurice overseas to serve as a Captain, in the Army Medical Corp in Malaya. He enjoyed his time there, as doctor to a British Army regiment, an Australian Army regiment and a Gurkha regiment – particularly his work supporting the Gurkha soldiers and their families.

On returning to the UK in 1957, Maurice secured a post as a House Officer in the department of obstetrics, gynaecology and genito-urinary medicine at King’s Lynn General Hospital in Norfolk, where he met his wife, Marian Pollyn, a midwifery sister. Originally, he planned to take up a further commission in the Army Medical Corp and thereafter to become a GP in Cornwall, but unfortunately in 1958, Maurice was diagnosed with TB, probably contracted in Malaya, and, after major lung surgery, he had to make significant changes to his career plans.

In 1959, Maurice went to the School of Public Health in London to study for a Diploma in Public Health, which enabled him to pursue a career as an epidemiologist and public health practitioner, initially for various County Councils and latterly for the National Health Service.

Maurice’s first post in Public Health was in Northampton, where he specialised in paediatric mental health and was very well-liked by doctors and children alike. In 1963, he accepted a post as Senior Assistant Medical Officer for the County of Norfolk. Then, in 1968, Maurice secured a post as Deputy County Medical Officer of Health for Nottinghamshire. In 1974, he was promoted again to the role of Area Medical Health Officer for South Yorkshire, where he made a significant contribution to the region’s public health services, including oversee-ing the opening of a new general hospital in Barnsley.

In 1979, Maurice’s career moved him back in Nottingham as Special Adviser for the East Midlands and Senior lecturer in Public Medicine at the University Medical School. This was the stage in his career he enjoyed the most, using his public health expertise to mentor students in their studies and research. Around this time, he was appointed Editor of the UK’s Public Health Journal – a post he held well into retirement, such was his ability to keep his medical knowledge current. Overseas, he was invited to participate in several academic fora as a special adviser to the World Health Organisation and to ASPHER, the international association for public health bodies. He travelled widely as an international consultant, (including assignments in Padua, Italy and for the Greek Government in Athens). He gave papers and participated in conferences, which he found particularly rewarding.

In the late 1980’s, Maurice’s role in Nottingham incorporated Director of Public Health Information and Computer Services, with responsibility for building a team to pilot the use of information technology in the NHS. In the last years of his career, Maurice became Director of Public Health for Nottinghamshire, where he was considered a wise counsellor and adviser by the Chairman of the Nottingham Health Authority Trust.
During his long career, Maurice published research into many areas of public health. His research on cardiac disease in Norfolk firemen subsequently led to the force adopting recommendations for important changes in shift management, stress reduction, diet and exercise. He produced a paper on “Milk and Infant Mortality” that updated advice on child nutrition. During the BSE crisis, he produced another on “Government Responsibility for Public Health Information to the Public” that set the standards in this area for the future. In policymaking, Maurice introduced the breast screening programme for women in Nottingham, and he made changes that ensured better provision for mental health for children and adults, and reforms within mental health institutions.

Maurice was a man of considerable intellectual capacity, a doctor with the culture and interests of a scientist, a classicist and a natural historian. He never lost his enquiring mind and the habit of continual learning. As an epidemiologist, he produced research and designed policy that contributed significantly to improvements in public health provision in this country and overseas. As a manager and teacher, he also had a deep insight into what made people well and happy at work – using that insight in his coaching and encouragement of his colleagues, students and friends in their personal development

Former colleagues describe Maurice as “a wonderful and inspirational leader”, who was always interested in the lives, experiences and views of others; “a friend who always had sound advice”; that he had “what is best in Doctors – a scientific approach combined with his love and knowledge of classics and art”; “a man of great wisdom and humour”; “an encouraging and challenging boss”, who “created a department that was exciting to work in, where ideas flowed and where people listened to each other”. Students described him as an “inspiring teacher” with a “door that was always open for practical advice and support based on his “real-world experience”, coupled with philosophical insights and a welcoming smile”. Finally, that he was “a blessing in my life as a mentor and a friend”; someone “who will always be remembered with great affection by all those who knew him”; and “who was a fair and clever colleague whose like will be rarely seen again”.

Maurice leaves his widow, Marian, his three daughters, and his three grand-daughters.

We all want public health action that we know will work. But how do we know what will work unless we build an evidence base by researching real-world actions?

To help Public Health researchers find these actions to research, NIHR and FPH are supporting a new system. Phinder is a website that lists interventions from across the UK that are open to being researched.

There has been an increasing recognition of, and frustration about, the separation of frontline public health practice from public health research (and vice versa). Public Health has ample opportunity to influence actions across a wide range of determinants of health. It has the opportunity to get involved in a myriad of actions that have the potential to impact on population health and health inequalities. However, there is often a lack of research evidence to inform these actions.

Meanwhile public health researchers are keen to undertake research that has impact in the real world, but don’t necessarily know what interventions are being developed or delivered that could benefit from research input. There may be many reasons for this. Researchers sometimes struggle to connect with practitioners in local government or the voluntary sector. They often work to very different time frames. And the budgets of practitioners for research are usually very limited.

So, some bright spark suggested “What we need is Tinder for public health!”

After a bit of word play the idea of “phinder” was born. Phinder aims to flag up real-world interventions to interested researchers. The website holds a searchable database of interventions that are accompanied by a small amount of detail and the contact details of someone involved with the intervention who is happy to talk about it further with researchers. Its aim is simply to broker connections between practitioners and researchers with a mutual interest in generating evidence to inform policy and practice.

To work well phinder needs a good stream of novel interventions from public health practice. We think phinder’s database of interventions will stimulate interest among researchers and facilitate new connections, leading to productive relationships.

We are keen to hear from those in practice about their interventions. It is easy to submit an idea – just fill in the simple online form and it will be uploaded to the web site and then tweeted by @researchphinder. Researchers can visit the web site regularly to view new opportunities, follow phinder on twitter or sign up for email alerts.

Phinder does not, unfortunately, offer a guarantee of research funding, nor an evaluation service. Researchers are invited to work with practitioners to develop, and then submit their applications for funding to whichever funder they think is most appropriate. The researcher-led stream of the NIHR Public Health Research programme is always open and proposals are reviewed three times a year. On the NIHR PHR web site you will find plenty of guidance, tools and tips to help develop a winning application.

So, let’s heal the divide between public health research and practice by feeding ideas for research into phinder and build an evidence base to help us take impactful action. All it takes is a little match-making.

Written by Prof Martin White, Programme Director of the NIHR Public Health Research programme, and Dr Helen Walters, Consultant Advisor to the NIHR Public Health Research programme.You can follow Martin on Twitter @martinwhite33 and you can follow Helen @PHev4LG.

I am delighted to have been asked to support the delivery of the Faculty’s introduction to public health course this Autumn. As a consultant that qualified to work via the defined specialist portfolio route with UKPHR, I am extremely encouraged that the FPH have given an opportunity to promote the portfolio as an alternative way of getting into senior public health roles. This is also very timely with the new UKPHR portfolio route that will come into place from September.

This course gives a good opportunity to those working, or considering working, in public health to gain an introductory understanding of the specialty and the other ways you can get into consultancy roles whether that be via the specialty registrar training or portfolio route.

Introducing information on the portfolio route comes as a result of feedback from the first introduction to public health workshop that was run last year. Many people were interested in understanding the range of routes into consultant roles and the course has been adapted to provide this. Not only will delegates get to gain new knowledge and (I hope) skills from the day-long workshop, they will also get a year’s associate membership with FPH which is a wonderful introduction to Faculty life.

I hope the course provides delegates with a balanced view of the options open to them to progress their careers. And I hope that delegates find my first-hand experience working through the UKPHR portfolio route and working as a consultant in local authority as useful and relevant as they decide their next steps.

Written by Steve Maddern, who is acting public health consultant at Wiltshire Council. He is responsible for the strategic delivery of service and programmes designed to influence behaviour change and improve health and wellbeing. Steve started his career in community pharmacy and has held a variety of public health roles at local, regional and national levels. He is registered with the UK Public Health Register and is a member of the Faculty of Public Health. You can follow Steve on Twitter @stevomadds.

Disclaimer

The aim of this blog is to encourage discussion and debate on public health issues. The views expressed here are the personal views of authors, and the content does not reflect the official position of the Faculty of Public Health. However, discussion generated here may be used to influence the development of organisational policy.